Density-Dependent Oviposition by Female Aedes albopictus (Diptera: Culicidae) Spreads Eggs Among Containers During the Summer but Accumulates Them in the Fall.

When possible, oviparous females should deposit eggs in sites that maximize the future performance of their offspring. Therefore, studies of oviposition behavior may uncover parameters important to offspring fitness. Gravid female Aedes albopictus (Skuse) were given a choice of containers with leaf infusion or plain water, either open or with a cover with a small opening, and their behavior was compared under summer (long day, higher temperature) or fall (short day, lower temperature) regimes. Open containers with leaf infusion were always preferred, but over time, summer females expanded their choices to oviposit in all containers and follow-up experiments indicated that the number of eggs laid was inversely correlated to the number of eggs present. In contrast, fall females laying diapausing eggs that do not hatch until the spring, accumulated eggs in open containers with food resulting in high egg densities. Combined, these results demonstrate a seasonal shift that suggests either high winter egg mortality or safety in numbers. It also demonstrates that female Ae. albopictus change their behavior based on cues associated with expected added risk, which varies across time and space. The wide distribution of summer eggs across container types may contribute to the fast expansion of Ae. albopictus across its invasive range, but egg accumulation in the fall may be exploited for control.

Bicycling movements as a manifestation of complex partial seizures of temporal lobe origin.

Alternating movements of the limbs during a seizure, especially bicycling movements of the legs, are often taken as strong evidence for the psychogenic origin of seizure activity in an adult population. A recent review of pseudoseizure manifestations concluded that alternating limb movements were "highly characteristic of pseudoseizures." We report two adult patients with complex partial seizures of temporal lobe origin, confirmed by ictal video EEG recording, in whom bicycling movements were the prominent ictal manifestation. Bicycling occurred 5-30 s after ictal onset and lasted 15-30 s. Use of video EEG recording continues to increase our understanding of the wide range of behaviors which may occur in the course of an epileptic seizure, particularly complex partial seizures. Few absolute clinical criteria remain to distinguish epileptic seizures from pseudoseizures. These two cases and one other reported case clearly remove bicycling movements from that category.

Initial experience with SPECT imaging of the brain using I-123 p-iodoamphetamine in focal epilepsy.

Nineteen patients with complex partial seizures refractory to medical treatment were examined with routine electroencephalography (EEG), video EEG monitoring, computed tomography or magnetic resonance imaging, neuropsychological tests and interictal single photon emission computed tomography (SPECT) with I-123 iodoamphetamine (INT). In 18 patients, SPECT identified areas of focal reduction in tracer uptake that correlated with the epileptogenic focus identified on the EEG. In addition, SPECT disclosed other areas of neurologic dysfunction as elicited on neuropsychological tests. Thus, IMP SPECT is a useful tool for localizing epileptogenic foci and their associated dynamic deficits.

Reperfusion arrhythmia: myth or reality?

Early reports of "reperfusion arrhythmia" after experimental temporary coronary occlusion raised concern that these arrhythmias, particularly ventricular fibrillation and ventricular tachycardia, might occur in association with reperfusion of an occluded coronary vessel during thrombolysis. Such an occurrence could increase the risk of transfer of such patients. To provide a more definitive answer to this question, we reviewed hospital and transfer records for all patients with acute myocardial infarction transferred by our critical care transfer service between January 1, 1985, and November 30, 1987, noting the occurrence of five types of arrhythmia: ventricular fibrillation, ventricular tachycardia, premature ventricular contractions, bradycardia, and atrioventricular block, both before and during transfer. Five hundred patients with acute myocardial infarction less than 48 hours old were transferred during this period. Two hundred twenty-five patients received thrombolytic therapy; 270 did not (five unknown). The type of acute myocardial infarction was known for 471 patients: 192 were anterior, 203 were inferior, and 76 were lateral. There were no deaths during transfer. Overall survival through hospitalization was 91%. The incidence of arrhythmia was 36% before transport and 12% during transport. There was no difference in arrhythmias overall, or with respect to any of the five arrhythmias specified, between patients who received thrombolytic therapy before and during transport and those who did not. Reperfusion arrhythmia does not appear to be a clinically significant entity during the transport of patients who are receiving IV thrombolytic therapy.

Use of tissue plasminogen activator in the emergency department for acute myocardial infarction.

Tissue plasminogen activator (t-PA) is a new intravenously administered thrombolytic agent currently being tested for emergency treatment of acute myocardial infarction (AMI). This report summarizes our clinical experience using t-PA to treat AMI in the emergency department and describes current protocols for its use in treating AMI. Between September 1985 and August 1986, t-PA was administered to 105 patients with AMI according to clinical research protocols. All were treated within six hours of the onset of pain. Thrombolysis was achieved in 80 patients (76%). Percutaneous transluminal coronary angioplasty was performed acutely for residual stenosis in 58 (55%). Thirty-three patients (31%) exhibited cardiac arrhythmias during treatment, 18 (17%) requiring emergency intervention. Periaccess hematoma developed in 50 patients (48%); transfusion of one or more units of blood was required in 22 of 97 (23%), excluding those undergoing urgent coronary artery bypass grafting. Overall 30-day survival was 94%. Recombinant t-PA appears to be an effective thrombolytic agent that may soon be standard emergency therapy for patients with AMI. Administration begun in the ED can achieve a high rate of reperfusion, but requires careful monitoring and the support of a coordinated acute cardiac care program, including emergency cardiac catheterization and cardiac surgery, to achieve the best results.

Global aphasia without hemiparesis: multiple etiologies.

Acute global aphasia without hemiparesis has been considered pathognomonic of embolic stroke. During 1 year, we encountered six patients with this syndrome. Two had multiple strokes, probably embolic. One had atrial fibrillation; at autopsy, there were metastases as well as multiple infarcts in the left hemisphere. One had a single large infarct in the territory of an anterior branch of the middle cerebral artery (MCA), one had subarachnoid hemorrhage of unknown origin, and one had a sylvian fissure hematoma with intraparenchymal extension from a ruptured MCA aneurysm. Nonembolic etiologies are therefore also possible and include conditions that bar anticoagulation.

Sleep disruption in the course of chronic levodopa therapy: an early feature of the levodopa psychosis.

Sleep disruption is a common complaint in levodopa-treated parkinsonian patients. A survey of 100 parkinsonian patients revealed prominent sleep complaints in 74%. Sleep complaints were unrelated to patient age and the duration of disease but increased in prevalence with longer periods of levodopa therapy. Sleep abnormalities tended to increase in severity with continued treatment and insomnia tended to be followed by daytime somnolence, altered dream events, and episodic nocturnal vocalization and myoclonus. While dyskinetic side effects and on-off syndrome were encountered in patients with and without sleep complaints, 98% of patients experiencing psychiatric side effects also reported sleep disruption. It is suggested that sleep-related symptoms constitute an early stage of levodopa-induced dopaminergic psychiatric toxicity in the parkinsonian population. Clinical and experimental observations suggest that serotonergic mechanisms are important in this symptom complex.

Hypothyroidism presenting as a gastric phytobezoar.

The manifestations of myxedema often occur insidiously over several months or years. Except for gastrointestinal symptoms, the diagnosis of hypothyroidism may not clinically evident. Especially in the elderly, symptoms of hypothyroidism are frequently unrecognized or simply dismissed as signs of old age.

Well-differentiated peripheral cholangiocarcinoma with an unusual clinical course.

A patient with an unresectable well-differentiated bile duct tumor who survived for 15 yr after biopsy diagnosis is presented. Histologic examination of the tumor revealed bland features of bile duct adenoma despite extensive spread within the liver. Over its subsequent course, the tumor progressively replaced the liver, achieving huge size, although there was no evidence of metastases until shortly before the patient's death. This clinical course was very unusual for either bile duct adenoma or cholangiocarcinoma, but would be more characteristic of another tumor of intrahepatic bile duct origin, the biliary cystadenoma. However, this latter diagnosis was excluded with both gross and microscopic pathologic criteria. Evidence is presented to support classification of this tumor as an unusual varient of peripheral cholangiocarcinoma which requires correlation of the clinical and pathologic findings for correst diagnosis.

Purulent rectal discharge associated with a nontreponemal spirochete.

A nontreponemal spirochete was isolated from the rectum of a homosexual man with a chronic purulent discharge. Known infectious causes of the disease were excluded. Although the pathogenicity of the organism was not proved, the patient's symptoms rapidly resolved following penicillin G benzathine therapy. When culture of a nonhemorrhagic, purulent rectal discharge fails to verify Neisseria gonorrhoeae, health care personnel are encouraged to carefully examine a Gram's-stained smear of the discharge for spiral-shaped organisms.

Small-intestinal mucosa in pseudoobstruction syndromes.

The purpose of this investigation was to determine the frequency and severity of small intestinal mucosal damage in pseudoobstruction syndromes. One hundred eighty-nine interpretable biopsies from 12 patients were blindly reviewed by two investigators. The underlying disorders were scleroderma in 7 and idiopathic intestinal pseudoobstruction in 5. All 12 had small-intestinal dilatation on small-bowel series. Eight of the 12 patients had biopsies characterized by moderate to severe mucosal damage; 3 of these had some biopsies which were flat. The damage did not correlate with: (1) types and numbers of organisms recovered from small intestinal aspirates; (2) duration of illness; (3) degree of dilatation of the proximal small bowel; (4) concentrations of deconjugated bile salts in small intestinal fluid; or (5) amount of fat absorbed in fat-balance studies. We conclude that mucosal damage is common in pseudoobstruction syndromes. The pathogenesis of the damage and its relationship to intraluminal bacteria remain undefined.

Gallium-67 scanning at 6 hr in active inflammatory bowel disease: case report.

Gallium citrate scanning at 6 hr was used to evaluate a patient with active ulcerative colitis. The localization of 67Ga in the colon correlated with the extent of the inflammatory process. When either colonoscopy or radiographic contrast studies are contraindicated, 67Ga scanning at 6 hr may prove useful in the evaluation of active inflammatory bowel disease.